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small fiber neuropathy
Etiology:
- diabetes mellitus (15%)
- idiopathic (70%)
Epidemiology:
- median age 54 years
- mean body mass index = 30.4 kg/m2
Pathology:
- peripheral neuropathy, sensory neuropathy & autonomic neuropathy
Clinical manifestations:
- distal pain without hyporeflexia or muscle weakness
- neuropathic pain, abnormal sensation to pinprick, heat, or cold
- autonomic dysfunction (generally mild)
- no motor weakness
- normal proprioception & vibratory sensation
- nearly all patients have cutaneous neuropathic pain in the lower extremities
- 17% have upper extremity involvement
Special laboratory:
- nerve conduction studies & electromyography are normal
- thermoregulatory sweat test
- quantitative sensory testing
- skin biopsy to measure intraepidermal nerve fiber density
Complications:
- development of large-fiber sensory & motor neuropathy (1/3)
General
sensory neuropathy
autonomic dysfunction (dysautonomia)
References
- Johnson SA et al.
Small fiber neuropathy incidence, prevalence, longitudinal impairments,
and disability.
Neurology 2021 Nov 30; 97:e2236.
PMID: 34706972 PMCID: PMC8641968 (available on 2022-11-30)
https://n.neurology.org/content/97/22/e2236